Open Letter to President Cyril Ramaphosa on Failure to Implement Legal Imperatives Surrounding Mental Health Care in South Africa

SAFMH News Room

Dear Honorable President,


First of all, we thank you for your attention. While mental health is certainly an unrecognized and neglected focus area, we note efforts to bring to light the failures in the system. It is our hope that these efforts will serve to realise the rights of people with psychosocial disabilities and intellectual disabilities. Today we wish to bring to the fore the failure to implement the laws and policies of the Republic as they relate to the mental health system with reference to the Life Esidimeni Tragedy and beyond.

First of all, we wish to remind you of mental health in the global context and of the international obligations of the Republic:

Globally, mental illness is strongly linked to health and social inequalities, and these inequalities affect large groups of people, whether these groups are defined socially, economically, demographically, or geographically. Certain groups in society are more vulnerable to experiencing mental health inequities, including: black and minority ethnic communities, homeless people, victims of violence and abuse, people living with disabilities, women and children. Those with severe mental illnesses are more likely to experience some of the most severe health inequalities. Inequalities in mental health and the dilapidated state of psychiatric facilities have significant ethical implication which involve key bioethics principles of medicine and public health that involves: respect for individuals, justice (equality and fairness), promotion of good, and to do no harm.

As a Member State of the United Nations and World Health Organisation, South Africa has an obligation towards the agreements adopted or endorsed at this level to ensure that its citizens’ human rights, health and mental wellbeing are underpinned in all local policies and legislation. At this level, world leaders have committed to recognise prevention and treatment of non-communicable diseases, of which mental, neurological and substance use disorders are included, as health priorities within global development. There can be no sustainable development without mental health and none of the Sustainable Development Goals can be achieved without prioritising mental health.

We turn now to national imperatives:

Chiefly, the Constitution of the Republic of South Africa (CRSA), Mental Health Care Act and the White Paper on the Rights of Persons with Disabilities as well as the Mental Health Policy Framework and Strategic Action Plan (MHPF) and National Development Plan are concerned with the right of dignity of service users. This is so because dignity is a right from which others flow- there is no real right to access to health care without dignity, for example. Other rights similar in nature are the rights to equality and life. Further applicable rights- those flowing from the aforesaid entitlements- are the rights to freedom and security of person and the right to a clean and healthy environment. We draw your attention to these rights, Honorable President, because they have been neglected, extinguished even, in respect of those among society’s most vulnerable. Applied correctly, the aforesaid instruments can facilitate the realization of each of these legal guarantees.

Honourable President, it is clear, the requisite instruments for creating a comprehensive and functional mental healthcare system indeed exist. Unfortunately implementation thereof is woefully inadequate. This was evidenced with both Life Esidimeni as well as within the status quo. The violations of these rudimentary entitlements led to death of some 144 mental health care users and the relapse of many others. Today, atrocities continue to occur throughout the system with death and destruction in the lives of individuals so-situated becoming a raging and rampant problem throughout the country. Applied correctly extant legislation and policy could ameliorate the plight of mental health care users, and South Africa could see a high rate of recovery and successful habilitation/rehabilitation. Unfortunately this is not the case. A comprehensive legal framework is meaningless if it is not implemented correctly, or in some cases at all. Until horror stories of poor or non-existent basic services subside, until mental health care users are able to obtain what is required in order to maintain a high standard of mental well-being, the drafting of the law, policies and plans concerned will remain a moot and futile expenditure of resources and effort.

Honourable President- to many mental health care users, the Life Esidimeni tragedy instilled emotions of anger, resentment, disappointment and distrust in the Department of Health, but also in Government in its entirety for failing to protect the lives of the former Life Esidimeni patients from suffering and from death. Many mental health care users are accessing services in the public health care system and are asking themselves “does my life mean as little to Government as the lives of the former Life Esidimeni patients?” The system as it presently stands- despite all of the scrutiny under which it has been placed- represents dereliction of duty on the part of your government and the fact that nobody is being held unaccountable renders the system to a state of wanton neglect.

Honourable President, we implore you to implement the obligations to which the state is bound, address the present shortcomings productively and systemically and hold those responsible for the glaring iniquities in the system to account.

It is greatly desirous that this communication will be addressed with a sense of urgency and that steps will be put in place to remedy the fatal defects in the system.

Yours Faithfully,

The South African Federation for Mental Health

Contact Details:
Nicole Breen
Project Leader: Awareness and Information
South African Federation for Mental Health
Tel: 011 781 1852
Cell: 072 2577 938

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